A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption

Abstract

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive care, topical and/or systemic steroids, and, recently, cyclosporine, the mainstay of management involves identifying and discontinuing the causative drug. This review article will provide an overview of FDE with an emphasis on its generalized bullous variant.

Keywords: FDE; GBFDE; SJS/TEN; Stevens-Johnson syndrome; drug rash; fixed drug eruption; generalized bullous fixed drug eruption; toxic epidermal necrolysis.

Figure 1

Examples of fixed drug eruptions (FDE). (A–C) Non-bullous FDE with the classic morphology of erythematous to violaceous, round to oval patches that may have a dusky center. (D,E) Examples of bullous/erosive FDE.

Figure 1

Examples of fixed drug eruptions (FDE). (A–C) Non-bullous FDE with the classic morphology of erythematous to violaceous, round to oval patches that may have a dusky center. (D,E) Examples of bullous/erosive FDE.

Figure 2

Characteristic histology of FDE shows vacuolar interface dermatitis, necrotic keratinocytes, and pigment incontinence (upper). Full thickness necrosis results in a subepidermal blister in acute rapidly evolving lesions (lower).